Healthcare Claims Specialist

Virtual Staffing Solutions; Cebu City; On-site; PHP 223,000 - 335,000; Full time

Job summary

Virtual Staffing Solutions, Cebu City, Philippines, is seeking a Claims Processor to join our team. The role focuses on reviewing customer-submitted claims to determine eligibility and coverage, and initiating the claims process with required documentation.

You will evaluate claim details, investigate for validity, and collaborate with adjusters, attorneys, and vendors to obtain necessary information. Accuracy and regulatory compliance are essential in maintaining records and reporting trends.

Qualifications

• 6 months to 1 year of BPO experience, preferably in healthcare.
• Experience in insurance, claims processing, or customer service is a plus.
• Strong analytical and problem-solving skills.
• Excellent communication (written and verbal) and interpersonal skills.

Responsibilities

• Review and assess claims submitted by customers to determine eligibility and coverage.
• Initiate the claims process by gathering necessary documentation and determining the extent of coverage.
• Evaluate claim details by reviewing supporting documents such as police reports, medical records, and other relevant information.
• Investigate claims to ensure validity and compliance with company policies.
• Collaborate with insurance adjusters, attorneys, and third-party vendors to obtain required information.
• Coordinate with internal departments such as underwriting or risk management when necessary.
• Maintain detailed and accurate records of all claims in compliance with company procedures and legal requirements.
• Update claim status in the company database and ensure proper documentation of all actions taken.
• Make decisions regarding claim approvals, denials, or settlements within established guidelines.
• Identify potential fraud and escalation suspicious claims to management for further investigation.
• Ensure claims are handled in accordance with industry regulations, company policies, and best practices.
• Prepare and generate reports on claims activities, trends, and outcomes for management review.

Skills

BPO experience

Healthcare domain knowledge

Insurance knowledge

Analytical skills

Communication skills

Problem-solving

Interpersonal skills

Job description

Virtual Staffing Solutions, Cebu City, Philippines, is seeking a Claims Processor to join our team. The role focuses on reviewing customer-submitted claims to determine eligibility and coverage, and initiating the claims process with required documentation.

You will evaluate claim details, investigate for validity, and collaborate with adjusters, attorneys, and vendors to obtain necessary information. Accuracy and regulatory compliance are essential in maintaining records and reporting trends.